Pressure to be perfect: Teens under the knife

'Already I have had a few parents looking to pay for boob jobs for their daughters as a reward for good marks in the Leaving Cert. These parents should know better.' Is cosmetic surgery for teenagers the latest US import? Louise Holden reports

MTV's I Want a Famous Face and US drama Nip/Tuck are just two of a raft of new television programmes focusing on cosmetic surgery. While surgical procedures to enhance physical appearance are not new, this is the first time that TV audiences have engaged so intimately with the processes and treatments available. But how are these images impacting on teenagers, who are more conscious of their appearance than any other group?

In the United States, cosmetic surgery is relatively common among teens, who often receive breast augmentation surgery or nose reshaping as graduation gifts. The quintessential US teen Britney Spears had her breasts enlarged aged 17. There is nothing like the same level of demand for plastic surgery from teenagers in Ireland, but growing awareness of the treatments available is starting to filter down to younger age groups.

According to a senior surgeon at the Irish Cosmetic Surgery Group, there has been a gradual increase the number of Irish teens looking for treatments such as nose reshaping, breast augmentation and ear pinning.

"Teenagers are liable to get fixated on a certain part of their body, such as their ears, nose or breasts," he says. "They can drive parents up the wall looking for surgical procedures to correct what they see as a problem. Parents need to take a balanced approach when deciding whether or not to take the matter further. For some teens, their preoccupation with changing their ears or nose may pass like last year's demands for a PlayStation. For others, there could be a real issue that needs to be addressed."

The most common surgical procedure carried out on under-18s in Ireland is otoplasty to pin back prominent ears. This is a relatively straightforward intervention and children as young as six years old have been known to present for treatment. In many cases, these children have suffered at the hands of bullies in school and parents are happy to take whatever measures are necessary to ease the child's passage through secondary school.

Surgeon Andy Skanderowicz of the Dublin Cosmetic Surgery Centre doesn't see much of an issue with carrying out otoplasty on young children who need it. Prominent ears are very common in Ireland, he counters, and can cause a great deal of misery for children.

He is not so universally approving on the subject of nose reshaping or breast augmentation, however.

"I have only carried out one breast augmentation on a 17-year-old and that was after extensive counseling with the patient and her parents," says Dr Skanderowicz. "In that case, the girl had no breast development at all and it looked likely that she wouldn't. She was so self-conscious about her chest that she has stopped going to school on PE days and her parents were very concerned."

Generally, however, Dr Skanderowicz dissuades teenagers from nose or breast reshaping. "The body continues to change and grow into the late teens and early 20s. Cosmetic surgery that is carried out too early can result in distortion. The bones in the nose, for example, do not fully take shape until 18 years old in a girl and 19 in a boy. I do get requests from 14- and 15-year-olds for reshaping, but I put them off until they are older."

Dr Skanderowicz has also had requests for fat-reduction surgery, or liposuction, from a number of teens and their parents, but he's not keen. "Liposuction is not a treatment for obesity. It can provide adults with the kick start they need to change their lifestyle, but I would always recommend diets and exercise to teens before surgery."

Some cosmetic surgery centres in Ireland have a policy of refusing treatment to anyone under the age of 18. Louise Braham of the Harley Medical Group explains why her company has taken this decision. "Teenagers' bodies are still changing and we steer clear of any surgical interventions on under-18s, including ear pinning. We are vehemently against these ridiculous programmes on television promoting procedures such as liposuction for teens."

Helena Ashdown-Shiels, managing director of Advanced Cosmetic Surgery in Dublin agrees. "Quite a few young girls come to us with their parents looking for breast enhancement. Legally we have to consult with them, but our surgeons will always tell them to wait until they are 18, if not longer. All these programmes coming from the US are giving young people ideas. Already I have had a few parents looking to pay for boob jobs for their daughters as a reward for good marks in the Leaving Cert. These parents should know better."

There are situations where surgical intervention at a young age can enhance a child's self-esteem and remove a serious social or physical obstacle. Breast-reduction surgery, for example, can make a huge difference where uneven proportions are causing a girl physical pain and embarrassment. If your child comes to you with a request for plastic surgery it's important not to dismiss them out of hand, says a senior surgeon at the Irish Cosmetic Surgery Group.

"Even if you are totally against the idea of cosmetic surgery, don't disregard the child's desires," he says. "Talk to them about their feelings. If they seem to be genuinely determined, research the area with them. Even going as far as a consultation might solve the issue. The surgeon is very likely to try and put the child off until he or she is older and they may put an end to the matter."

Ashdown-Sheils is glad that many adults now have the confidence to address physical hang-ups that have inhibited them all their lives. She is not so happy about the quick-fix image of cosmetic surgery that is being portrayed in TV, however. "Whenever I meet young girls these days who find out what I do for living, they are quick to list the procedures they plan to get - breast enhancement, liposuction and so on. I say the same thing to all of them - forget surgery and get some exercise."